| NPI | 1114907482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CO 298) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CO 298) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO 298) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2015-07-01 |